Endoscopist-directed balanced propofol sedation is safe and effective in patients undergoing outpatient colonoscopy

• Published in: Journal of Digestive Endoscopy Vol. 6; no. 4; pp. 158 - 162
• Main Authors: Nathan, Joseph H., Klein, Amir, Gralnek, Ian M., Khamaysi, Iyad
• Format: Journal Article
• Language: English
• Published: A-12, Second Floor, Sector -2, NOIDA -201301, India Thieme Medical and Scientific Publishers Private Ltd 01.10.2015; Medknow Publications and Media Pvt. Ltd; Thieme Medical and Scientific Publishers Pvt. Ltd
• Subjects: Anesthesiologists; anesthesiology; balanced propofol sedation; Colonoscopy; conscious sedation; Dosage and administration; endoscopy; Methods; moderate sedation; monitored anesthesia care; Original Article; Patient care; Practice; Propofol; Safety and security measures; conscious sedation; propofol; moderate sedation; balanced propofol sedation; endoscopy; Anesthesiology; colonoscopy; monitored anesthesia care
• ISSN: 0976-5042; 0976-5050
• DOI: 10.4103/0976-5042.173961

Abstract Background and Aims: Propofol administered in combination with other moderate sedation medications (balanced propofol sedation [BPS]) is an appealing and effective sedation regimen for gastrointestinal (GI) endoscopy procedures. However, product labeling dictates propofol be administered only by anesthesiology personnel. We evaluated the safety of endoscopist-directed as well as anesthesiologist-administered BPS during outpatient colonoscopy. Methods: We performed a retrospective cohort study using prospectively collected endoscopy data where endoscopist-directed BPS is standard practice. Measured patient outcomes included: BPS drug dosages, postcolonoscopy oxygen saturation levels, pulse, and systolic/diastolic blood pressures, need for mask bag ventilation or endotracheal intubation, aborted colonoscopy due to sedation, hospital admission postcolonoscopy, and mortality. Results: From April 1 to November 30, 2013, 1036 patients undergoing outpatient colonoscopy (mean age 56.4 years, 55% males, 32% American Society of Anesthesiologists [ASA] I, 59% ASA II, 9% ASA III) received endoscopist-directed BPS. During the same time period, 40 patients (mean age 66.6 years, 55% males, 33% ASA II, 67% ASA III) received anesthesiologist-administered BPS. Indications for colonoscopy for the endoscopist-directed BPS included 352 (34%) colorectal cancer screening/surveillance, 404 (39%) evaluation of lower GI symptoms, 156 (15%) positive fecal occult blood, and 124 (12%) inflammatory bowel disease. BPS dosages (mean ± standard deviation) per patient were Fentanyl 0.05 mg (fixed dose), midazolam 1.6 mg ± 0.5 mg (range: 1-5 mg), and propofol 104 mg ± 62 mg (range: 10-460 mg). Propofol doses correlated inversely with patient age (r = −0.35; P < 0.001), and the mean Propofol dose was lower as ASA score increased: ASA I - 115 mg, ASA II - 103 mg, and ASA III - 75 mg ( P < 0.01). No patient required bag mask ventilation, endotracheal intubation, or hospital admission. There were no aborted colonoscopies secondary to sedation and no mortality. All patients were discharged directly to home. Conclusions: Endoscopist-directed BPS appears safe and effective for low-, intermediate- and high-risk patients undergoing outpatient colonoscopy.